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Reflections on the American Psychiaatric Association's annual meeting

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This past week we attended the annual meeting of the American Psychiatric Association in New Orleans, Louisiana. Our cab driver said that he'd been all over the world, but New Orleans had the best food of anywhere. He might be right. Ah," the food! Much more interesting than the meeting! The oysters were incredible and so were the sauces. And we didn't even make it to the "cutting edge" restaurants, as told to us by a local psychiatrist whose passion is food and who attended the course we gave on Narrative hypnosis. By we, I mean myself and my colleague in the Coyote Institute, Barbara Mainguy, who is a hypnotherapist, among other credentials. We had hoped that other colleagues from the Coyote Institute could attend, but that was not possible.

Coyote Institute is a not-for-profit corporation founded for the study of change and transformation. Of course, coyote is the North American symbol for change and transformation. Wherever coyote goes, change happens. Coyote's original distribution mirrors his role as symbol which is the West Coast (all the way to Northwest Washington) spreading eastward to the Mississippi River, and filling the Great Plains of the U.S. and Canada. Today, coyote is the only species of animal who distribution is actually growing, so she must know something about coping with modern life.

Speaking of change and transformation, the A.P.A was markedly different from two years ago and even last year in San Francisco. The presence of the pharmaceutical companies has greatly diminshed. Some change has occurred, and we're not sure what it is, but the A.P.A. seems to have distanced itself from the inudstry. Unlike Washington, D.C.'s meeting, the buses were not panel to panel drug ads. No people rode segues distributing ads about drugs. We saw fewer industry sponsored symposia, and it was hard to find a pen.

I have written before about how unfortunate it is that drugs have become the mainstay of American and even world psychiatry. There is no question, that some people require drugs to remain stable. However, the idea that drugs are the first-line treatment seems preposterous. Yes, this is the state of community mental health in most of the developed world.

In my conventional psychiatry practice, most patients expect that medication will make them feel "normal". We have convinced them to believe this. We have convinced them that the vicissitudes of their emotional swings are entirely chemical and should and can be managed by chemicals. Sleep is the best example. Almost everyone wants something to make them sleep. Sleep is a a major income stream for the pharmaceutical companies, and one in which nothing really performs. A recent double-blind, randomized, controlled study showed that people sleep, on average, 4 minutes longer each night, when taking Ambien. Many drugs make people sleepy when taken at night, but this side effect usually wears off in 2 weeks. For example, quetiapine (brand name, Seroquel) and trazodone (brand name Desyrl) and mirtazapine (brand name Remeron) all make people very sleepy. These drugs are prescribed for their side effects, which seems like a questionable practice. The side effects wear off. The drugs no longer make people sleep. But people keep taking the drugs. Increasing the dose will bring back side effects for another two weeks or so, but how high can the dose go? A recent meta-analysis of controlled trials of sleeping agents found that nothing works better than over-the-counter diphenhydramine (brand name Benadryl), which itself doesn't work all that well.

We know how important sleep is. In a recent lecture on NPR about sleep, we heard that teenagers who get 15 more minutes of sleep, on average, every night, grades increased from "C's" to "B's". Schools with later starting times produce more people in the top 15% of standardized tests. In a study on teenagers, eighty percent of depression cleared up when people sleep. The symptoms of depression begin right away when we start losing sleep. Perhaps those extra four minutes of sleep with Ambien are worth something!

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Lewis Mehl-Madrona graduated from Stanford University School of Medicine and completed residencies in family medicine and in psychiatry at the University of Vermont. He is the author of Coyote Medicine, Coyote Healing, Coyote Wisdom, and (more...)
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